Pathshala Registration Form for the Year September 2017 - June 2018

(Note – A child must be in Pre-K and/or 4 years old as of September 2017 to attend the Pathshala. Adult Swathyay members are NOT required to fill out this form – this form is only for students from Pre-K to Grade 12 )

(Visit www.jsne.org for Pathshala information)

Last Name of Family
*

Father's Name
*

Mother's Name
*

Address 1

Address 2

City

State

Postal / Zip Code

Phone Number (Home)

-
Area Code Phone Number

1st Preferred Cell Phone
*

-
Area Code Phone Number

2nd Optional Cell Phone

-
Area Code Phone Number

1st Preferred Email Address
*

2nd Optional Email Address

(Note – The above email addresses will be added to the JSNE yahoo email group for all communications)